Insurance Terms

Insurance provides protection against future risks, accidents and uncertainties. We have compiled a glossary of insurance terms and definitions that are commonly used in the industry.

insurance terms

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Deductibles

The amount you must pay for covered health care services before your Health Insurance Kicks in.

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Copay

Insurance co-payments are percentages of claims that the insured agrees to pay from their own pocket regardless of the claim's amount.

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Coinsurance

The act of splitting or spreading risk among multiple parties is called coinsurance.

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Out-of-Pocket Max

An out-of-pocket maximum refers to the maximum amount an individual must pay out of pocket and not be reimbursed.

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Formulary

A list of prescription drugs covered by a prescription drug plan or by another insurance plan providing prescription drug coverage.

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Inpatient

Medical treatment or care received while admitted to a hospital or healthcare facility.

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Preferred Providers

Healthcare providers within a network that offer services at a lower cost to insured individuals.

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Preferred Allowance

The maximum amount that an insurance plan will cover for a specific medical service or treatment.

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Non-Preferred Provider/Out of Network Providers

Healthcare providers or facilities that are not contracted with an insurance plan and may result in higher out-of-pocket costs.

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Network Area

Geographic region or area where an insurance plan's network of healthcare providers is available for coverage.

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Usual, Customary & Reasonable Charges

Standard fees for medical services that are considered reasonable and customary within a specific healthcare market.

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Explanation of Benefits

An explanation of benefits summarises the services received and the amount the insurance company as well as the insured will pay.

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Prior Authorization

A health plan's cost-control process that requires the health care providers to obtain prior approval from the health plan before they can deliver a specific service to a patient.

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Funding Accounts

Premiums are paid into an account along with excess-of-loss reinsurance payments, which are used to pay insurance claims.

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Premium

As part of the risk coverage, an insured pays a periodic premium to the insurer. It is known as a premium bill.

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ER, Urgent Care, or PCP

In a health care plan, the primary care physician manages all aspects of patient care.

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Sum Insured

Sum Insured indicates the maximum coverage under Insurance contract in terms of financial amount which Insurance company is liable to pay in case of an equivalent loss to or expenses incurred by the insured.

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Pre-existing Disease

It is the type of ailment which Insured have suffered from before the start date of the Insurance contract.

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Accidental Death and Dismemberment (AD&D)

AD&D refers to loss of Life, Limb or Sight. Limbs and Sights are regarded as “Members”.

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Personal Accident

Any expenses incurred due to accident during a trip abroad. Accident means sudden, unforeseen and involuntary event caused by external, visible and violent means.

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Emergency Dental Pain

Expenses incurred on acute anaesthetic treatment of a natural tooth or teeth during a Trip abroad but not exceeding the Sum Insured for the coverage as mentioned in Part I of the Schedule hereto

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Personal Liability

In case of insured becomes legally liable to a third party under statutory liability provisions in private law for an incident which results in death, injury or damage to the health of such third party or damage to his/her properties.

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Bail Bond

Bond to be paid to the appropriate authority/court as the bail amount towards the arrest or detention for a bailable offence by the police/judicial authorities of the place at which he has specified in the proposal form whilst.

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Family Visit

Immediate Family Member is needed to be at his bedside for the duration of his stay in the hospital where Insured is hospitalized for more than 7 consecutive days, and his medical condition forbids his shift to home country.

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Mental illness and alcohol disorder

Illnesses related to Mental health and disorders related to substance such as alcohol. Coverage for the expenses thereof upto the maximum specified against this benefit is present in some of the Indian Insurance plans.

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Loss of baggage and passport

Total loss of checked-in baggage and passport during travel.

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Trip Cancellation and delay

Cancellation or delay of the flights. The reason of Flight cancellation and delay should not be from the passenger’s side.

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Financial Emergency Assistance

Assistance in terms of financial amount in case of any emergency.

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Preferred or In-network provider

Healthcare professionals or facilities that have signed contracts with an insurance company for reduced rates are known as preferred or in-network providers.

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TITERS

Blood tests that evaluate immunity by counting the number of antibodies present in a person's body.

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Preventive Care Services

Services in the field of medicine that emphasise staying healthy or early disease detection.

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Prescription Drugs

Medications that can only be obtained with a doctor's prescription.

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